Effect of eccentric-based rehabilitation on hand tremor intensity in Parkinson disease

Improving Healing: The Putative Effects of Low-Level Laser Therapy for Ulcer in Parkinson's Disease

The progressive nature of Parkinson's disease and its associated motor and non-motor symptoms can lead to various complications when patients experience immobilization, exacerbating existing motor impairments and potentially giving rise to secondary health issues. The variability, progression, and management of tremors in PD can be challenging. Due to low bone mass density, patients with Parkinson's disease are susceptible to vitamin D deficiency. The lack of movement can worsen muscle rigidity and stiffness, leading to contractures and a decreased range of motion in joints. Additionally, immobility may contribute to cardiovascular deconditioning, orthostatic hypotension, and an increased risk of pressure ulcers due to prolonged pressure on specific areas of the body. In this case report, we hereby report a case of Parkinson's disease further complicated by sinus discharge from the ulcer. This case report describes the putative effects of low-level laser therapy on discharging sinus from the wound secondary to a diabetic ulcer in idiopathic Parkinson's disease. Achieving an ideal level of functional independence and preventing problems associated with extended immobility are essential goals of structured physical therapy postoperative care. This may assist the patient in returning to their pre-injury position more quickly. Our patient underwent several interventions for wound healing, including proprioception training, tremor management, improving dynamic trunk balance, and pain control measures. Clinical outcome measures like the Barthel Index, lower extremity functional scale, and Visual-Analog Scale were used to assess the progress of the patient. Managing these interconnected conditions requires a multi-disciplinary approach.

Effects of upper limb vibratory stimulation training on motor symptoms in Parkinson's disease: an observational study

OBJECTIVES

Parkinson's disease is characterized by motor and non-motor symptoms. Tremor is one of the motor symptoms that can affect manual skills and have an impact on daily activities. The aim of the current study is to investigate the effect of upper limb training provided by a specific vibratory device (Armshake®, Move It GmbH - Bochum, Germany) on tremor and motor functionality in patients with Parkinson's disease. Furthermore, the training effect on global cognitive functioning is assessed.

DESIGN

An uncontrolled before-after clinical trial.

PATIENTS

Individuals with diagnosis of Parkinson's disease, motor upper limbs deficits, and absence of dementia.

METHODS

Participants underwent a 3-week programme (3 times a week) and was evaluated before, after, and at 1 month follow-up by motor (Fahn Tolosa Marin Tremor Rating Scale, Unified Parkinson's Disease Rating Scale - part III, Purdue Pegboard Test, Disability of the Arm, Shoulder and Hand Questionnaire) and cognitive (Montreal Cognitive Assessment) scales.

RESULTS

Twenty subjects are included. After treatment a statistically significant improvement in tremor, manual dexterity and activities of daily living was found. The data indicated no effects on global cognitive functioning.

CONCLUSION

These findings suggest positive effects of vibratory stimulation training on upper limb motor symptoms in Parkinson's disease.

Development and Performance Evaluation of a Smart Upper-Limb Rehabilitation Exercise Device

User-friendly rehabilitation medical devices can enhance health and the quality of life through the convergence of information communication and medical technology. Muscle contraction enables bodily movement, and the assessment of muscle strength is crucial. Muscle contraction includes isometric, isotonic, and isokinetic types. Many individuals with physical disabilities rely on wheelchairs due to lower-limb paralysis. There is a substantial correlation between the level of upper-limb functional recovery and the quality of daily life. This study aimed to design and evaluate a device that utilizes various muscle contractions to enhance the effectiveness of upper-limb rehabilitation exercises. The results from the isometric performance assessment showed percentage error rates of >30% for 5-30 kg. Correction equations were employed, and the isometric performance assessment resulted in error rates below 2.1% for 5-30 kg. Isokinetic performance assessment using video analysis evaluated a consistent wire speed from 10 cm/s to 70 cm/s with an average error rate of 0.91% across all speeds. This study demonstrates the ability to accurately measure various muscle contractions and showcases the potential for real-time feedback. This highlights how such a device could be helpful for target groups, including older adults and individuals with disabilities, during upper-limb rehabilitation exercises.

Added forearm weights for gait pattern normalization in patients with Parkinson's disease

Patients with Parkinson's Disease presented gait impairment. Applying additional weights to enhancing sensory input may improve gait impairment. We assumed that gait impairment could be improved when patients walked with additional forearm weights, and the gait improvement was associated with clinical characteristic of Parkinson's Disease. Thirty patients with Parkinson's Disease and 30 age-sex matched controls were recruited. Spatiotemporal and joint kinematics parameters were evaluated by a three-dimensional motion capture system in normal walking and walking with sandbags, respectively. The comparisons of spatiotemporal parameters were analyzed using t-test or nonparametric tests. The comparison of joint kinematic data was analyzed using statistical parametric mapping. The correlation between motor symptom and gait parameters changes was analyzed using Pearson's correlation analysis. During normal walking, patients showed deteriorated gait compared with controls. After applying weights to forearms patients increased cadence (p = 0.004), speed (p < 0.001) and step length (p = 0.048), and decreased stride time (p = 0.003). The hip angles significantly increased during 5%-23% and 87%-100% of gait cycle, while knee angles during 9%-25% and 88%-98% of the gait cycle, and ankle angles in 92%-100% of gait cycle. The gait parameters of patients with forearm-loading showed no significant difference compared with healthy subjects walking normally. The change of gait parameters correlated positively with the axial and tremor severity while correlated negatively with the rigidity sub-score. Patients with tremor dominant subtype also showed greater improvement of speed and step time compared with patients with postural instability/gait difficulty subtype. Applying added weights bilaterally to the forearms of patients can normalize gait patterns. Notably, patients with higher scores on axial and tremor and lower rigidity scores gained more benefits.

Supporting Tremor Rehabilitation Using Optical See-Through Augmented Reality Technology

Tremor is a movement disorder that significantly impacts an individual's physical stability and quality of life, and conventional medication or surgery often falls short in providing a cure. Rehabilitation training is, therefore, used as an auxiliary method to mitigate the exacerbation of individual tremors. Video-based rehabilitation training is a form of therapy that allows patients to exercise at home, reducing pressure on rehabilitation institutions' resources. However, it has limitations in directly guiding and monitoring patients' rehabilitation, leading to an ineffective training effect. This study proposes a low-cost rehabilitation training system that utilizes optical see-through augmented reality (AR) technology to enable tremor patients to conduct rehabilitation training at home. The system provides one-on-one demonstration, posture guidance, and training progress monitoring to achieve an optimal training effect. To assess the system's effectiveness, we conducted experiments comparing the movement magnitudes of individuals with tremors in the proposed AR environment and video environment, while also comparing them with standard demonstrators. Participants wore a tremor simulation device during uncontrollable limb tremors, with tremor frequency and amplitude calibrated to typical tremor standards. The results showed that participants' limb movement magnitudes in the AR environment were significantly higher than those in the video environment, approaching the movement magnitudes of the standard demonstrators. Hence, it can be inferred that individuals receiving tremor rehabilitation in the AR environment experience better movement quality than those in the video environment. Furthermore, participant experience surveys revealed that the AR environment not only provided a sense of comfort, relaxation, and enjoyment but also effectively guided them throughout the rehabilitation process.

Physical therapy interventions for the management of hand tremors in patients with Parkinson's disease: a systematic review

BACKGROUND

Several physical therapy modalities have been used to improve hand tremors in patients with Parkinson's disease (PD). However, little is known about the efficacy of these techniques. Therefore, we conducted this study to synthesize evidence from published studies on the efficacy of physical therapy techniques for hand tremors in PD patients.

METHODS

We followed the PRISMA statement and Cochrane handbook guidelines when conducting this study. We conducted an electronic literature search of PubMed, Cochrane Central Register of Clinical Trials, Web of Science, Ovid, and Embase, and then we selected clinical trials assessing the efficacy of any physical therapy intervention for hand tremors in patients with PD. Study outcomes were extracted, and evidence was synthesized narratively.

RESULTS

A total of six modalities described in six studies were included in this systematic review. Out of the six interventions, the tremor's glove and electrical stimulation showed significant improvements in root mean square angular velocity (59% and 43.8%, respectively) and UPDRS tremor score (P < 0.05 for both). Also, eccentric exercises were associated with significant reductions in the mean resting tremor amplitude (P < 0.05). These data were dependent on single studies; therefore, a meta-analysis was not feasible.

CONCLUSION

Several physical therapy interventions, such as electrical stimulation, exercises, transcranial low voltage pulsed electromagnetic fields, weights, and virtual reality showed promising results in reducing hand tremors. However, this evidence was based on a limited number of included studies, and more RCTs with larger sample sizes are required to confirm the efficacy of these interventions.

Motor performance, motor impairments, and quality of life after eccentric resistance training in neurological populations: A systematic review and meta-analyses

BACKGROUND

Many overlapping factors impair motor performance and quality of life in neurological patients. Eccentric resistance training (ET) has potential benefits for improving motor performance and treating motor impairments better than some traditional rehabilitation approaches.

OBJECTIVE

To estimate the effect of ET in neurological settings.

METHODS

Seven databases were reviewed up to May 2022 according to PRSIMA guidelines to find randomized clinical trials involving adults with a neurological condition, who underwent ET as set by the American College of Sports Medicine. Motor performance (main outcome) was assessed as strength, power and capacities during activity. Secondary outcomes (impairments) were muscle structure, flexibility, muscle activity, tone, tremor, balance and fatigue. Tertiary outcomes were risk of fall, and self-reports of quality of life.

RESULTS

Ten trials were included, assessed using Risk of Bias 2.0 tool, and used to compute meta-analyses. Effective effects in favour of ET were found for strength and power, but not for capacities during activity. Mixed results were found for secondary and tertiary outcomes.

CONCLUSION

ET may be a promising intervention to better improve strength/power in neurological patients. More studies are needed to improve the quality of evidence underlying changes responsible for these results.

Effect of Upper Limb Motor Rehabilitation on Cognition in Parkinson's Disease: An Observational Study

Parkinson's disease is characterized by motor and cognitive deficits that usually have an impact on quality of life and independence. To reduce impairment, various rehabilitation programs have been proposed, but their effects on both cognitive and motor aspects have not been systematically investigated. Furthermore, most intervention is focused on lower limb treatment rather than upper limbs. In the present study, we investigated the effect of 3-week upper limb vibratory stimulation training on cognitive functioning in 20 individuals with Parkinson's disease. We analyzed cognitive (Montreal Cognitive Assessment, Trial Making Test, Digit Symbol, Digit Span Forward and Backward and Alertness) and motor performance (Unified Parkinson's Disease Rating Scale-part III; Disability of the Arm, Shoulder and Hand Questionnaire) before treatment, at the end of treatment and one month post treatment. After rehabilitation, a statistically significant improvement was observed in terms of global cognitive status, attention, global motor functioning and disability. The results suggest an impact of upper limb motor rehabilitation on cognition in Parkinson's disease. Future studies on neuromotor interventions should investigate their effects on cognitive functioning to improve understanding of cognitive motor interaction in Parkinson's disease.

Effect of Zhan Zhuang Qigong on upper limb static tremor and aerobic exercise capacity in patients with mild-to-moderate Parkinson's disease: study protocol for a randomised controlled trial

INTRODUCTION

Currently, the first choice for the clinical treatment of static tremor in Parkinson's disease (PD) is drug therapy, however side effects are common. In recent years, the effects of physical therapy on PD has become a serious research focus. Studies have indicated that aerobic and resistance exercises alleviate PD movement disorders and improve aerobic capacity, but the effects of Qigong on PD static tremor and aerobic capacity remain unknown.

METHODS AND ANALYSIS

OBJECTIVE: To observe the effects of Zhan Zhuang Qigong on upper limb static tremor and aerobic capacity in patients with PD, we established a rigorous randomised, parallel-controlled, assignment hidden, evaluator-blinded protocol.

METHODS

Seventy-two patients with PD, at the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, were recruited and randomly divided into a control (n=36) and experimental group (n=36). The intervention group received conventional medicine plus Zhan Zhuang Qigong exercises five times a week at 30 min each time, over an 8-week period. The long-term effects of Zhan Zhuang Qigong on PD was investigated after the intervention. Phyphox APP, CRST, CPET, UPDRS(II, III) were used to evaluate tremor, aerobic capacity, and motor function in groups.

DISCUSSION

We are investigating the effects of Zhan Zhuang Qigong on upper limb static tremor and aerobic capacity in patients with PD. If positive are identified, they will add a new research direction and evidence for the clinical exploration of exercise therapy for PD.

ETHICS AND DISSEMINATION

This study was approved by the Ethics Committee of Shandong University of Traditional Chinese Medicine (Approval Number: 2021-025-KY). The Committee will be informed of any changes to the trial protocol, such as intervention intensity, outcome indicators and data collection. Study results will be presented as a paper at an international conference or in a journal.

TRIAL REGISTRATION NUMBER

ChiCTR2100053529.

Physical Therapist Management of Parkinson Disease: A Clinical Practice Guideline From the American Physical Therapy Association

A clinical practice guideline on Parkinson disease was developed by an American Physical Therapy Association volunteer guideline development group that consisted of physical therapists and a neurologist. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches for management of Parkinson disease. The Spanish version of this clinical practice guideline is available as a supplement (Suppl. Appendix 1).

Validity and Reliability of the Persian Version of Parkinson's Disease Sleep Scale-2

OBJECTIVE

Sleep problems are nonmotor symptoms in Parkinson's disease that should be carefully evaluated for better management and treatment. Parkinson's Disease Sleep Scale (PDSS-2) is one of the most reliable tools for measuring sleep difficulties in people with Parkinson's disease. This study investigated the psychometric properties of the Persian version of PDSS-2.

METHODS

Four hundred and fifty-six people with Parkinson's disease with a mean age ±standard deviation of 60.7 ± 11.3 years were engaged in this study. Acceptability was assessed by floor and ceiling effects. Dimensionality was measured by exploratory factor analysis. The convergent validity of PDSS-2 with the Hospital Anxiety and Depression Scale (HADS) was assessed. Internal consistency and test-retest reliability were assessed with Cronbach's alpha and intraclass correlation coefficient (ICC), respectively.

RESULTS

No noticeable ceiling and floor effect was detected. The dimensionality analysis showed three factors. A high correlation was obtained between PDSS-2 and HADS (anxiety subscale). Excellent internal consistency with α = 0.94, and good test-retest reliability with ICC = 0.89 were obtained.

CONCLUSION

This study showed that the Persian version of Parkinson's Disease Sleep Scale has acceptable validity and reliability for measuring sleep disturbances in people with Parkinson's disease.

A randomised controlled trial on effectiveness and feasibility of sport climbing in Parkinson's disease

Physical activity is of prime importance in non-pharmacological Parkinson’s disease (PD) treatment. The current study examines the effectiveness and feasibility of sport climbing in PD patients in a single-centre, randomised controlled, semi-blind trial. A total of 48 PD patients without experience in climbing (average age 64 ± 8 years, Hoehn & Yahr stage 2–3) were assigned either to participate in a 12-week sport climbing course (SC) or to attend an unsupervised physical training group (UT). The primary outcome was the improvement of symptoms on the Movement Disorder Society-Sponsored Revision of the Unified Parkinson’s Disease Rating Scale part III (MDS-UPDRS-III). Sport climbing was associated with a significant reduction of the MDS-UPDRS-III (−12.9 points; 95% CI −15.9 to −9.8), while no significant improvement was to be found in the UT (−3.0 points; 95% CI −6.0 to 0.1). Bradykinesia, rigidity and tremor subscales significantly improved in SC, but not in the unsupervised control group. In terms of feasibility, the study showed a 99% adherence of participants to climbing sessions and a drop-out rate of only 8%. No adverse events occurred. This trial provides class III evidence that sport climbing is highly effective and feasible in mildly to moderately affected PD patients.

Effect of Exercise on Parkinson's Disease Tremor: A Meta-analysis Study

Background:

Prior studies suggest that exercise may prevent movement disorders in Parkinson’s disease (PD) patients. In this meta-analysis, the pooled effect of exercise on PD-induced tremor was investigated.

Method:

Relevant published studies (n = 7) were retrieved by searching major databases, including Scopus, Web of Science and PubMed from 1985 to November 2020. Studies were eligible if the effect of exercise on PD-induced tremor was studied and sufficient information for calculating the effect size was reported. Furthermore, non-English manuscripts and studies related to non-human species were excluded. The quality of studies was evaluated using the improved Newcastle-Ottawa scale (NOS). In this study, variables such as participant’s age and gender, type of exercise, intervention duration and tremor indices were extracted for each study. Between-study heterogeneity and publication bias were calculated using I² statistic and funnel plot, respectively.

Results:

Results showed that hand movement and cycling exercises were effective for reducing tremor amplitude or frequency. When all types of exercises (upper, lower or whole-body movement) were considered, an odds ratio (OR) greater than 1 was obtained (log(OR) = 2, 95% CI: 0.88–3.12), while between-study heterogeneity was high (I² = 78%). By restricting the studies to hand-movement exercises, a lower odds ratio (log(OR) = 1, 95% CI: 0.24–1.77) with small between-study heterogeneity (I² = 0.0%, p = 0.502) was obtained. Statistical analysis based on Egger’s and Begg’s tests revealed no significant publication bias.

Conclusions:

Outcomes of this study suggested that exercises as inexpensive, non-invasive and easy-to-implement strategies could be applied for PD patients alongside medical interventions for reducing tremors.

Clinical Highlights

Predictors of Instrumental Activities of Daily Living Performance in Patients with Stroke

Objective

Instrumental activities of daily livings are important for independent living and active participation in the community. The present study is aimed at determining factors predicting instrumental activities of daily living performance in patients with stroke.

Methods

In this cross-sectional study, a convenient sample of 90 patients with stroke entered from five occupational therapy centers, which were selected based on the cluster randomization method. Lawton IADL scale, Barthel Index, Trail Making Test (A and B), Digit span subtest of Wechsler memory scale, Motorcity index, and Beck Depression Inventory-II were used to investigate the study's aim. Statistical analyses were performed using independent sample t-test, one-way ANOVA, Pearson correlation, and multiple linear regression analysis.

Results

Age (r = −0.384, p < 0.001), memory (r = 0.565, p < 0.001), basic activities of daily living (r = 0.818, p < 0.001), depression (r = −0.758, p < 0.001), Trial Making Test _(B-A) (r = −0.614, p < 0.001), and motoricity index (r = 0.670, p < 0.001) were significantly associated with instrumental activities of daily living performance.

Conclusions

Basic activities of daily living were the strongest predictor of IADL's performance. Age, TMT _(B-A), and depression were orderly the next strongest predictors. Stroke patients with more dependency in basic activities of daily living, older age, cognitive impairment, and depression are more opted to be dependent in instrumental activities of daily living and as a result, less participation in home and community affairs.